Apply to become an organizational member of GCHA

Contact Information

Organization Name

Organization Street Address (Optional)

Country Postal Code (Optional) City (Optional) State/Province (Optional)

Organization Email - please share a general email address, such as info@yourorganization.com (Optional)

Organization Twitter Handle (Optional) Organization Facebook Profile URL (Optional)

Key Contact First Name Key Contact Last Name

Preferred Language (Optional)

Key Contact Email Home Phone (Optional)

(Optional)

Your role within the organization

I am retired

As the key contact for this organization, I agree to be added to the...

GCHA Member Google Group

Newsletter

ADDITIONAL INFORMATION

Why does your organization want to join GCHA?

Please share a short description of the organisation’s activities, including its interest in or work on climate change

Which health groups do you represent or work with most often? (Optional)

Organization Website

GEOGRAPHIC INFORMATION

What region of the world does your organization work in? (based on WHO Regions) (Optional)

If you are based in the Pan American Region, would you like to join the Latin American and Caribbean Network? (Optional)

Yes, We would like to be considered for the Latin American & Caribbean Region Network

MEMBERSHIP AGREEMENTS

I/we have read and agree to GCHA's membership information

Our organization endorses the Doha Declaration

Our organization endorses the calls made in the 2021 Health Climate Prescription

Our organization does not take money from tobacco companies, weapons/arms companies or fossil fuel companies